The power of medical device data: Going beyond the EMR

It is no secret that medical devices are able to accumulate extensive amounts of patient data. Oftentimes, this data is underutilized. Could there be a way to harness the power of medical device data to improve the delivery of patient care? We spoke with Kevin Phillips and Monica Demers of CapsuleTech, and they offered their insight.

Many feel the true power of patient information resides within the EMR. How do you see medical device data influencing our industry?

The power of medical device data is the ability to apply a largely untapped resource of real-time patient and device data to a host of additional information systems and applications to help improve and facilitate patient care, operational efficiency, as well as help manage medical device assets and infrastructure.

Historically, much of the focus in healthcare data has been on the EMR – whether it is CPOE, clinical documentation, meds, imaging, etc. So, typically, our clients start with connecting and sending medical device data to their EMR. Until recently, there’s only been limited discussion on what else this “real-time, status of the patient” information can do when integrated with other systems. 

Lately, client interest has started moving beyond the EMR to use medical device data for other applications such as alarm management, clinical decision support, patient surveillance, and clinical research systems. In this world of accountable care and population health management, it is critical that providers know the status of their patients, and be notified as soon as possible of an adverse event or the potential of an adverse event – even when they away from patient. Having timely and accurate medical device data propagated to multiple systems in parallel – not just the EMR – can increase the value of patient data being collected. 

We are most excited about discovering new problems to solve with the vast amount of data that never gets used for documentation. We’ve looked “under the hood” of medical devices to know what other types of data can be utilized. We see a wealth of data that, when you add some basic patient, user, and location context, it inspires some potentially powerful use cases that support clinical decision-making and operational efficiencies.  

Your recent infographic depicts how up to 1,000 parameters of data is being produced every second, and how much of this data is not being utilized. Why has so much data gone so underutilized for so long?

Contrary to popular belief, widespread automated medical device integration is a relatively recent development, within the last five years. Only progressive organizations had this integration, but it wasn’t until the HITECH act and Meaningful Use where we saw an uptick in EMR implementations and replacements – which led to medical device integration projects. Even within this short timeframe, the main focus has been on expanding connectivity of new device types (the input) – and not on expanding integration to other systems (the output). It has just been in the last few years that we are seeing movement in hospitals to implement other valuable systems such as alarm management, patient surveillance, etc. and are discovering what other data can be used to help improve care delivery.

When we look at the type of data available in a medical device we see three broad types of data: physiologic data such as vital signs, waveforms, and physiologic alarms; treatment details such as drug name, drug concentration, and volumes; and device settings such as unique device IDs, firmware versions, modes, infusion rates, and device alarms. Most of this data captured from each device is not charted in the clinical documentation system, which leaves a lot of data underutilized. 

We see this as our opportunity to educate the industry about what the data can do beyond the automation of vital signs documentation. In a very real sense, these point-of-care devices provide as close to a real time picture as possible of the health of both patients and the devices themselves.

How does Capsule unlock the power of this data? What are you doing differently than your competitors?

Our approach is holistic. We have a systems approach to medical device data and we call it SmartLinx, a medical device information system. We chose this term because we likened it to a laboratory or radiology information system – where we are an end-to-end data management collection, management, and communication solution that not only supplies data to the EMR, but to other systems that need it; as well as the foundation of a medical device analytics platform.

The first step to unlocking the data is to connect the devices. Ours is an enterprise, vendor-neutral approach to medical device connectivity. We have a device driver library of over 730 interfaces covering virtually any bedside medical device, and several connectivity options. This means hospitals don’t have to standardize to one medical device vendor to solve their integration needs. 

The second step is to integrate the data. Integration sounds straightforward but what is not known is that medical devices are architected to send data to a single system, typically an EMR for documentation. When you start to look at sending to other systems, the requirements change – hospitals have to vary the data feeds by parameter type, by rate, and even sometimes do some simple mapping for another system to accept and interpret the data. This requires a more sophisticated system that can handle many inputs and manipulate it to multiple systems simultaneously.

Finally, what more can you do with the data? This is where we’re innovating. The timeliness of the data is really critical when it comes to bedside analytics to aid in clinical decision-making. We’ve introduced an Early Warning Scoring System to our low acuity spot monitoring integration and charting solution. This powerful capability capitalizes on the current vital signs rounding workflow where vital signs are taken, charting takes place, and a score is calculated – all within seconds at the bedside. In the future, we’ll continue to evolve this workflow to reduce the technology and workflow steps, as well as find new ways analytics can be best utilized.

Do you have a use case for how this process has worked?

Recently one of our clients expanded their medical device integration in their med-surg units to include the Early Warning Scoring System. Their initial rollout of our SmartLinx Chart Xpress solution (low acuity vital signs rounding solution) was a huge success – nurses felt a noticeable reduction in charting time which allowed them to spend more time on overall patient care; as well improvements in reporting of safety checks and compliance with treatment protocols through additional fields collected during the workflow. 

Building upon that success, this client wanted to capitalize on the timeliness of the data captured at the bedside by implementing the Early Warning Scoring System – an aid to detect patients at risk of deterioration at the earliest possible moment. Since this is a recent go-live, they are still collecting results – but here are some early perceived benefits they shared with us:

• Increased communication between patient care tech and registered nurse. 
• Increased number of complete set of vital signs in the record
• Improved truthfulness of respiratory measurement due to the sensitivity of the respiratory threshold in the algorithm
• More direct patient time

We have another client who has a mature alarms committee and utilizes all their alarm data to help identify and assess which alarms are sounding the most, why are they alarming, and whether there are ways to reduce the alarms that are going off. By classifying their alarms as low, medium, and high priority – they are able to then hone in on the low priority alarms and understand whether workflow needs to change – perhaps set tighter alarm limits.

How is Capsule’s technology helping improve the management of healthcare data within a facility? How does it improve patient care beyond the use of an EMR?

Our core value proposition when it comes to healthcare data is a single solution to integrate all your bedside medical devices across the facility. One flexible solution is an asset to both the users (streamlined, standardized workflows) and the IT and biomedical engineering folks that support them. Data is funneled from all types of medical devices from different vendors, aggregated, and normalized into a single stream and sent to critical systems to provide comprehensive, accurate data for clinical decision-making.

There are many ways we help improve care delivery. From a clinical workflow perspective our solutions are designed to make data capture more efficient while at the same time, provide comprehensive and timely automated documentation. This allows providers to reinvest time in patient care. 

In addition, our ability to send uniquely tailored information to multiple systems enables a myriad of new opportunities that allow care providers “on the go” to know how their patient is doing from alarm management/notification type systems to just having the same data in different clinical repositories. 

And finally, having the “freshest” medical device data is crucial for effective clinical decision support. This enables the earliest calculation, or indication that a patient may be at risk, helping to avoid unnecessary, costly care.

What’s the future? What is the ideal use case scenario for data in 5 years or 10 years?

In the short term, we believe that there are still improvements to be made on the collection and communication side of capturing medical device data. There is more and more technology at the bedside and there is a great need to simplify workflow by converging these technologies into a single platform. In the near future we’ll be launching the first of its kind vital signs monitor – combining vital signs monitoring, connectivity, documentation, and clinical decision support, all with a large, user-friendly interface in one innovative bedside solution. On the communication side, we continue to expand our collaborations with vendors that utilize medical device data.

The longer-term future is focused on the applications of timely medical device data: how the un- or under-utilized medical device parameters can be used not only for near-real time bedside clinical decision support, but also for trending and longer term analysis of operational effectiveness. We are developing ways to help identify medical device utilization: how long has a device been in use; what location; providing the ability to help justify purchasing (or non-purchasing) decisions; and optimize their asset allocation.